What is concierge nursing?
Concierge nursing is nursing care at home that a family arranges and pays for directly, led by a registered nurse. The nurse works from the person's doctor's orders, for the hours the family chooses, and is the family's single point of contact. It is not a Medicare benefit, and it does not replace the person's doctors.
The word concierge describes the arrangement, not a different kind of nurse. The nurse is a licensed RN, and in California an RN's work includes observing signs and symptoms, judging whether they are abnormal, then reporting, referring or starting emergency procedures, and giving medicines a physician ordered (California Board of Registered Nursing). What changes is who arranges the care: the family, directly, rather than an insurance plan.
Concierge nursing is also not concierge medicine. It is nursing care, and diagnosis and prescribing stay with the person's own doctor.
What is a concierge nurse?
A concierge nurse is the registered nurse who leads that care. People also search for the same role as a nurse concierge, a nursing concierge, a concierge RN or a private nurse. For what the nurse does on a visit, which credentials to expect and how to check a California license, see what a concierge nurse does.
How does concierge nursing work?
It usually starts with a phone call, then a care plan and agreed hours. The nurse works from the doctor's orders, visits or stays for the hours set, reports changes to the doctor and keeps the family updated. The plan and the hours change as needs change.
How concierge nursing usually works
- A first call: the family describes what is happening at home. At WholeHealth Concierge this is a free 15-minute phone consultation.
- A plan and hours: the care plan, the level of nurse and the hours are agreed with the family.
- The doctor's orders: the nurse works from the person's physician's orders. Diagnosis and prescribing stay with the doctor.
- Nursing at home: visits or shifts, including overnight or 24-hour nursing when needed.
- Reports and updates: changes go to the doctor, and the family hears what was seen.
Source for the nursing role: California BRN, scope of RN practice.
Hours are set by the family and the care plan: a few visits a week, longer shifts, overnight care or 24-hour care. See private duty nursing and overnight, 24-hour and live-in nursing.
Concierge nursing can sit alongside Medicare home health rather than replace it. Home health covers part-time or intermittent skilled care for people who qualify (Medicare.gov), and private nursing can cover the other hours.
Who is concierge nursing for?
Concierge nursing suits families who need more nursing time, more coordination or more continuity than Medicare home health gives, or who do not qualify for home health. Common moments are a hospital discharge, recovery after surgery, a new diagnosis, a long-term condition at home, or a loved one living alone.
Six common reasons families call
Concierge nursing may not be what you need if Medicare home health already covers it, if the only help needed is bathing, dressing and meals, or if the person has chosen hospice. Medicare covers home health for people who are homebound and need part-time skilled care (Medicare.gov), and hospice for people whose doctors certify a life expectancy of 6 months or less and who choose comfort care (Medicare.gov). For a new baby at home, see newborn and postpartum care.
What does a concierge nurse do at home?
A concierge nurse monitors, helps, coordinates, teaches, reports and advocates. In practice that means watching for changes, helping with the medicines and treatments the doctor ordered, keeping one medicine list across every prescriber, teaching the family what to watch for, reporting to the doctor and speaking up at appointments.
- Monitor how the person is eating, sleeping, moving and breathing, plus skin and any new confusion, so changes are noticed.
- Help with medicines and treatments the physician ordered, such as wound care, within the RN's scope (California BRN).
- Coordinate one current medicine list across every prescriber, plus follow-up visits, equipment and the other people helping at home.
- Teach the family the warning signs to watch for and the routines the doctor and therapists set.
- Report changes to the doctor early, and write down what was seen for the family.
- Advocate for the person at appointments and during hospital stays, with the history and medicine list in hand.
Diagnosis, prescribing and therapy plans stay with the person's physicians and therapists. WholeHealth Concierge does not provide hospice, dialysis or physical therapy. For what each type of worker may do in California, see who can legally do what, and for the nurse's side of a visit, see what a concierge nurse does.
How is concierge nursing different from home health, private duty nursing, home care and hospice?
Medicare home health is part-time skilled care for people who are homebound, ordered by a provider. Hospice is end-of-life comfort care. Non-medical home care helps with daily living. Private duty nursing is one-to-one nursing for the hours a family books, and concierge nursing is private nursing led by an RN who also coordinates the wider care.
Concierge nursing, private duty nursing, Medicare home health, home care and hospice, compared
| Concierge nursing | Private duty nursing | Medicare home health | Non-medical home care | Hospice | |
|---|---|---|---|---|---|
| What it is | Private nursing at home led by an RN, who also coordinates doctors, medicines and family updates | One-to-one nursing at home for the hours the family books, from visits to 24-hour care | Part-time or intermittent skilled nursing and therapy for people who are homebound (Medicare.gov) | Help with bathing, dressing, meals and company; not nursing | End-of-life care for people with illnesses that cannot be cured (Medicare.gov) |
| Who pays | The family, privately; some long-term care insurance policies may reimburse | The family, privately, or long-term care insurance if the policy covers it | Medicare, for people who qualify. You pay nothing for covered home health services (Medicare.gov) | Usually the family; Medicare does not pay for personal care when it is the only care needed (Medicare.gov) | Medicare Part A covers hospice care if you are eligible (Medicare.gov) |
| Hours | Set by the family and the care plan | Set by the family, including overnight and 24-hour shifts | In most cases up to 8 hours a day combined, and 28 hours a week (Medicare.gov) | Set by the family | Set in the plan of care with the hospice team (Medicare.gov) |
| How it starts | A call to the provider; nursing care follows the doctor's orders | A call to the provider; nursing care follows the doctor's orders | A doctor or provider sees the person in person and orders it, and a Medicare-certified agency provides it (Medicare.gov) | A call to the provider | The hospice doctor and regular doctor certify a terminal illness, and the person chooses comfort care (Medicare.gov) |
Concierge nursing and private duty nursing overlap. Both are private-pay nursing for one person. The word concierge usually signals that the RN also owns the coordination: the medicine list, the doctors and the updates to family. WholeHealth Concierge is an RN-led practice that offers both.
Medicare does not pay for 24-hour-a-day care at home (Medicare.gov), and it does not pay for long-term care, also called custodial care (Medicare.gov). For more depth, see concierge nursing vs. home health and nursing or hospice.
Why should a concierge nurse be a registered nurse?
Because the work depends on clinical judgment. California's Board of Registered Nursing describes RN practice as observing signs and symptoms, deciding whether they are abnormal, then reporting, referring or starting emergency procedures, and giving medicines a physician ordered. A caregiver is not a nurse, and an LVN works under the direction of an RN or physician.
In the Board's words, the RN role includes "observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition and determination of whether these exhibit abnormal characteristics" (California BRN, NPR-B-03). For LVNs, aides and caregivers, see who can legally do what in California.
You can check any RN's license yourself on the DCA License Search. The Board of Registered Nursing says the license information there "is primary source data from the Board of Registered Nursing licensing system called BreEZe" (California BRN). Step by step: how to verify a nurse's license.
WholeHealth Concierge is led by its founder, Meagan Williams, RN, BSN, CCRN, California RN license 95328380. Her RN license and CCRN certification are listed on our About page, with a link to check the license.
Does Medicare or insurance pay for concierge nursing?
Usually not. Medicare covers part-time home health for people who qualify, but it does not pay for 24-hour care at home or for long-term custodial care, so concierge nursing is usually paid privately. Long-term care insurance, VA Aid and Attendance and a medical expense tax deduction can each help in some cases.
What Medicare home health and hospice cover, in numbers
Medicare. Medicare does not pay for "24-hour-a-day care at your home", and it does not pay for custodial or personal care "when this is the only care you need" (Medicare.gov). If you have a Medicare Advantage Plan, Medicare.gov says to check with your plan about home health benefits. See does Medicare cover private duty nursing.
Long-term care insurance. Coverage depends on each policy. California's HICAP program offers free, confidential, one-on-one counseling on Medicare and long-term care insurance at 1-800-434-0222 (California Department of Aging). See long-term care insurance for home nursing.
Veterans. VA Aid and Attendance adds monthly payments to a VA pension for qualified veterans and survivors, including those who need another person's help with daily activities like bathing, feeding and dressing (VA.gov).
Taxes. The IRS lets you include amounts paid for nursing services, including services in the home, in medical expenses, and only medical expenses above 7.5% of adjusted gross income are deductible on Schedule A (IRS Publication 502). See can you deduct in-home care on taxes and ask a tax adviser.
WholeHealth Concierge is private pay only. We do not bill Medicare or insurance. For every option side by side, see how to pay for in-home care in California.
How much does concierge nursing cost?
It depends on the number of hours, whether nights or 24-hour care are needed, the level of nurse (RN, LVN or aide) and how complex the care is. WholeHealth Concierge does not publish its rates; we go through the hours with you on a free 15-minute consultation.
For market figures and how families budget, see choosing concierge nursing: questions, costs and who pays and our cost guide. Whether it is worth it for your family is covered in is it worth the cost.
Where can you get concierge nursing in Orange County and Southern California?
WholeHealth Concierge provides concierge nursing across Orange County, Los Angeles County, Riverside County and San Bernardino County. The practice is RN-led and private pay, and care starts with a free 15-minute phone consultation at (213) 298-3288.
Orange County
Los Angeles County and the Inland Empire
Free local help in Orange County
For other services for older adults, the OC Office on Aging runs an Information and Assistance Call Center at (714) 480-6450 (OC Office on Aging). For free counseling on Medicare and long-term care insurance, California's HICAP program is at 1-800-434-0222 (California Department of Aging). WholeHealth Concierge is not affiliated with either program.
How do you choose a concierge nurse?
Check that each nurse holds a current California license, ask who leads the care and who you call at night, ask how the nurse works with your doctors, and get the plan, the hours and the costs in writing. Our guide to choosing concierge care has the full list of questions and the ways families pay.
Read choosing concierge nursing at home: questions, costs and who pays, see what is included, and check the nurse's credentials with our license check steps.
What to have ready for the first call is in our guide to choosing concierge nursing.